Journal of Pain & Palliative Care Pharmacotherapy最新文献

Home-based palliative care (HBPC) improves quality of life by addressing distressing physical, psychosocial, and spiritual symptoms. However, symptom and medication burdens remain prevalent challenges. This study sought to characterize symptom prevalence and severity, the associated medication burden, and determine opportunities for deprescribing in the setting of HBPC. Patients referred to a home-based palliative care practice over a two-year period were included; 109 patients met inclusion criteria. Mean age was 78 years (± 11.8), and average Charlson Comorbidity Index (CCI) was 6.4 (± 2.7). The mean Palliative Performance Scale (PPS) score was 53.1, indicating moderate functional impairment. Patients reported a mean of 4.1 symptoms, with pain, depression, and lack of appetite being most common. Mean total number of medications was 11.1 (SD = 5.4), with 24% taking 15 or more medications. Average medication complexity score was 31.3 (± 16.9). Sub-optimally managed symptoms were identified in several domains, especially depression, pain, tiredness, and anxiety. Adverse Drug Reactions (ADRs) were documented in 49.5% of patient records. Opportunities for deprescribing were identified in 38.5%. Patients receiving HBPC experience significant symptom and medication burden. Optimization of symptom management and medication regimens, including targeted deprescribing, may reduce medication burden and improve outcomes.

Methadone and buprenorphine are commonly utilized to manage chronic pain and opioid use disorder (OUD), yet data on their prescribing trends remain limited. This multi-center retrospective study examines the use of methadone and buprenorphine in-patient medication orders across three University of California health systems over a 10-year period between the beginning of 2014 and the end of 2023. The analysis included 3,754 hospitalized patients with OUD and 4,990 hospitalized patients with chronic pain. Our study findings suggest that methadone may have been the primary treatment for chronic pain and OUD over the time frame, but buprenorphine use considerably increased over the latter portion of the decade for OUD, especially among younger patients and those with psychiatric comorbidities, reflecting national efforts to expand access. Laboratory findings may highlight the prevalence of comorbidities, particularly among methadone-treated patients. Methadone in-patient medication orders were estimated to have higher morphine equivalent daily doses (MEDDs) compared to buprenorphine. The decline in MEDDs and opioid prescribing for chronic pain over the study period align with broader public health initiatives aimed at reducing opioid-related harm and using non-opioid alternatives for analgesia. Prospective studies are needed to confirm the trends identified in this study.

Suzetrigine represents a novel non-opioid option for managing acute postoperative pain. Management of this pain often relies on traditional analgesics, including opioids, NSAIDs, and acetaminophen, but the use of these agents can be complicated by significant side effects and patient variability in response. This systematic review and meta-analysis aimed to assess the efficacy and safety of suzetrigine compared to placebo in adults with acute postoperative pain. A literature search was conducted across multiple databases from inception to July 25, 2025, which identified randomized controlled trials (RCTs) evaluating suzetrigine or its analog VX-548. Primary outcomes included standardized pain intensity difference at 48 h and incidence of adverse events. Four RCTs involving 2,768 patients undergoing abdominoplasty or bunionectomy were analyzed. Results showed that suzetrigine significantly improved SPID48 scores compared to placebo (mean difference [MD] = 38.76; 95% CI: 28.97-48.54; p < 0.00001) with minimal heterogeneity (I² = 5%). It also reduced the risk of overall AEs (RR = 0.86), nausea (RR = 0.72), and dizziness (RR = 0.57), without increasing serious AEs. No significant differences were observed for constipation, headache, vomiting, or moderate AEs. These findings suggest that suzetrigine offers effective and well-tolerated analgesia, supporting its role in opioid-sparing postoperative pain regimens.

A key component of multimodal analgesia that enhances postoperative pain control is the wound infiltration of local anesthetics after surgery. Diphenhydramine is known to have local analgesic effects; however, it is unclear how well it works to lessen postoperative catheter-related bladder discomfort (CRBD) following pyelolithotomy. From 2022 to 2024, 82 eligible patients participated in this double-blind randomized controlled trial. Participants were randomly assigned to receive either diphenhydramine (20 ml, 0.5%) or lidocaine (20 ml, 1%) for wound infiltration prior to closure. As the primary outcome, the Visual Analog Scale (VAS) for the recovery period and the first 24 h following surgery was assessed. There were no statistically significant differences in the baseline characteristics. VAS demonstrated that diphenhydramine offered pain relief similar to that of lidocaine during the postoperative period, with significantly lower scores at 18 h (p < 0.001). The occurrence of CRBD was markedly reduced in the diphenhydramine group (p < 0.001), as was the intensity of CRBD (p < 0.001). Furthermore, the diphenhydramine group exhibited a significant reduction in analgesia requirements and total opioid consumption (p < 0.001). Compared to lidocaine, diphenhydramine infiltration considerably lowers postoperative pain and the requirement for opioids while increasing sedation levels following pyelolithotomy surgery.

There are many treatments for Post-burn pruritus, but no consensus has been reached on the best option. This study aimed to compare chlorpheniramine mesotherapy with oral gabapentin for the treatment of post-burn pruritus. A single-blind, randomized trial involving 44 patients with hypertrophic scars and post-burn pruritus compared gabapentin (Group A: 300 mg, 1-3 times daily for 2 months) to mesotherapy with chlorpheniramine (Group B: 1-3ml of 10 mg/ml for 3 sessions, 1 week apart) on surrounding healthy skin. The primary endpoint was pruritus intensity (VAS), and the secondary endpoint was quality of life (DLQI). Side effects were monitored. Chlorpheniramine mesotherapy showed significant results in VAS and DLQI at each follow-up time-point compared to oral gabapentin (p < 0.05) except on the 28th day and 2nd month of follow-up. At the 2nd month, the gabapentin group achieved statistically greater improvements on both measures compared with the chlorpheniramine group (p < 0.001). Chlorpheniramine mesotherapy showed statistically significant short-term efficacy in reducing pruritus intensity and improving quality of life compared with oral gabapentin in burn patients with hypertrophic scars. However, given the study's limited follow-up period and lack of objective measures, further research is needed to assess long-term efficacy and broader clinical applications.

Sickle cell disease (SCD) is an autosomal, recessive, genetic disorder that affects the structure and function of the hemoglobin. Pain is the hallmark of SCD, and opioids and nonsteroidal anti-inflammatory drugs are the mainstay of SCD pain control during vaso-occlusive crisis (VOC). Intravenous (IV) access is mostly used for opioid administration in emergency departments. Most people with SCD often need frequent venipuncture for IV access for medications, fluids, and transfusions. The frequent venipuncture sometimes damages their veins, making it difficult to establish or maintain IV access for therapies during VOC, prompting the need for alternative parenteral routes of opioid administration for pain management. This article aims to summarize existing evidence on alternative routes of opioid administration to provide support for their use in acute SCD-related pain. Literature search for human studies was conducted through Pubmed, Ovid, ProQuest, EBSCOHost, Scopus, National Institute of Medicine, Google Scholar, and governmental agency websites. Systematic reviews, randomized control trials, cohort studies, and clinical guidelines published in English between 1984 to 2025 were included. Future clinical research should be conducted on the safety and effectiveness of using alternative routes of opioid administration in individuals with SCD.

Chemotherapy-induced peripheral neuropathy (CIPN) is a common, often debilitating side effect of oxaliplatin, a standard treatment for colorectal cancer. CIPN can cause pain, functional impairment, and cold hypersensitivity, frequently leading to treatment modifications that impact both quality of life and clinical outcomes. Although risk factors are known, no validated tools exist to predict an individual's CIPN risk, limiting opportunities for proactive management. This study explored patient and clinician perspectives on CIPN risk, its effects on treatment and daily life, and the potential value of risk prediction. Semi-structured interviews were conducted with six patients with colorectal cancer treated with oxaliplatin and six clinicians (four oncologists, two nurse practitioners) from an academic hospital. Thematic analysis identified shared concerns and needs related to CIPN. Clinicians consistently described neuropathy as oxaliplatin's most concerning side effect and reported that it often necessitated dose modifications. Patients reported sensory disturbances, functional limitations, and significant lifestyle disruption. Both groups expressed strong interest in tools to predict CIPN risk, with clinicians emphasizing the importance of clinically actionable, accurate, and workflow-integrated approaches. Findings highlight the potential of CIPN risk prediction to improve care and support treatment decisions, while demonstrating the need for strategies that balance efficacy with quality-of-life considerations.

Proportionate palliative sedation (PPS) is an important therapeutic option for patients at the end of life who experience intractable suffering despite use of all conventional interventions. Clinical guidelines for PPS differ between institutions, often tailored to local practice patterns and the regulatory environment. While professional organizations encourage institutions to develop tailored PPS guidelines, the literature lacks robust discussion of the development process. In this article, we present two cases from Yale New Haven Hospital, and explore the associated practical and ethical challenges, in the absence of clear institutional guidelines. We then describe the policy development process that followed these cases and discuss how defined PPS guidelines not only ensure patient comfort and autonomy but also mitigate decisional fatigue and moral distress among clinicians. As further guidance, we offer an ethical analysis and our own institution's PPS policy, available upon request. We encourage other institutions that are similarly committed to patient-centered care and the moral support of clinicians and caregivers to develop PPS guidelines.

Tramadol is a prescription opioid analgesic which was first approved in the U.S. in 1995. Tramadol was not a controlled substance on the federal level until August 2014 when it was classified as a Schedule-IV controlled substance. Even with it becoming a controlled substance, its utilization increased in the following years and is the second most prescribed opioid in the U.S. behind hydrocodone products. Recent research highlights tramadol's potential for psychological or physical dependence. Therefore, the objective of this article was to review all studies assessing the impact of tramadol on chronic opioid utilization and/or opioid misuse compared to other therapies. Ten published studies showed tramadol had comparable or higher risk of chronic opioid utilization and/or opioid misuse compared to other opioids, while six studies showed tramadol had a significantly lower risk. This article intends to review these findings, providing rationale and potential policy implications. While there may be some residual confounding, confounding by indication, or unmeasured biases contributing to the results seen showing higher risks, it is still concerning given the number of studies that demonstrated these findings.

Objectives: Intrathecal opioids may not be effective for severe refractory pain associated with cancer. Intrathecal ketamine may be effective in reducing pain in these cases, however, there is legitimate concern regarding ketamine neurotoxicity. We present our experience using intrathecal ketamine in 17 consecutive patients in one clinic, as well as, a case report of one patient who received intrathecal ketamine for 36 wk.

Materials and methods: A retrospective case review included all patients treated with intrathecal ketamine at one center. The primary outcome was dosing required to change pain intensity and signs of neurotoxicity.

Results: Seventeen patients received intrathecal ketamine, data was available on 11. Mean ketamine concentration was 794 mcg/ml. Mean basal dose was 341 mcg/day. All 11 experienced pain reduction. One experienced auditory hallucinations.

Conclusion: This study provides more data supporting the safety and efficacy of intrathecal ketamine in this population. While neurotoxicity is a concern, our experience has been positive.